Published: January 23, 2008 09:13 pm            

Breast cancer is No. 10 killer disease in Wabash Valley

TERRE HAUTE — When it comes to breast cancer detection and treatment, we’ve come a long way, Baby. But, with breast cancer coming in at number 10 on the top 10 lists of diseases that kill people in the Wabash Valley, we’re not “there” yet.

In 2004, breast cancer killed 37 people in Clay, Parke, Sullivan, Vermillion and Vigo counties. Hopefully, that number will decrease as diagnostic tools continue to improve and the overall incidence of breast cancer decreases.

Dr. Karen Tisinai, a general surgeon at AP&S Clinic who performs breast surgery, knows firsthand about breast cancer: One of her grandmothers had breast cancer, as did an aunt. She herself has undergone three biopsies to check for breast cancer.

“In the past few years, the number of new diagnoses have finally started to go down,” she says, a fact she attributes to cessation of hormone replacement therapy and a decrease in smoking.

HRT, also known as estrogen replacement therapy, was stopped in 2002, she says. That was after research found a significant increase in the risks of breast cancer, heart attacks, strokes, and blood clots among those who were using it.

“I think most [breast cancers] are estrogen-driven,” she says.

Estrogen is a generic term for the various female sex hormones. The estrogens — estradiol, estriol and estrone — are responsible for breast development and other secondary sex characteristics in females and produce an environment favorable for fertilization, implantation and nourishment of early embryos.

Tisinai named several risk factors for breast cancer that involve a longer period of estrogen output, including being younger than average when beginning to menstruate, older than average at menopause, and being older when you have your first child or are childless.

Smoking also can increase incidence of breast cancer and diet and environment also might have an effect, she says.

“Several decades ago, Japanese women had a low incidence [of breast cancer],” Tisinai says. But that changed in Japanese women who moved to the United States when they were girls, she adds, raising the possibility that the change in diet and environment had a negative effect.

But extensive education and better diagnostic equipment also may have had an impact on lower the number of cases.

Tisinai’s hands described a large rectangle in the air as she extolled the advantages of digital mammograms. Rather than use a magnifying glass to attempt to locate tiny lesions in the breast, she can now enlarge the picture to a size that allows her to see them and still maintain resolution.

“Doctors have 17-inch monitors and the mammogram is transferred back to their monitors,” says Lydia Kruse, a mammography technician and manager at Clara Fairbanks Center for Women at 1505 N. Seventh St.

“They have the ability to zoom up on little tiny areas in that image,” Kruse adds. “They’re looking for little grains of salt. If calcifications are … in groups of more than three, it’s suspicious of a malignancy forming. With the ability to [magnify] images and adjust some of the techniques, we’re catching very small and earlier cancers. That results in better treatment plans and a better prognosis. The death rate has declined tremendously because of earlier detection from the newer technologies we have now.”

Digital mammography also has an advantage when it comes to women who have dense breast tissue. “Film comes out real light” on women with dense breasts, Kruse says, adding that, with digital images, “dDcs have the capability to adjust the techniques and the images are getting a lot better.”

As far as the person having a mammogram is concerned, there is no difference in the “pressing” experience: You’ll still have your breasts compressed. “We’re just trying to spread that tissue out,” Kruse says.

However, there is a difference in time. Because there is no need for film to be developed to see if images need to be retaken, the time it takes to have a mammogram is cut nearly in half, from about 15 minutes to 8 minutes, Kruse says.

Between 65 and 70 mammograms are performed at Clara Fairbanks each day. The facility also includes boutique services for women who need breast prostheses and has a certified, licensed fitter.

“We like to advise a mammogram at age 35 for a baseline then, if there is not clinical indication [of breast cancer], come back at [age] 40,” Kruse says.

Mammograms can be complemented with MRIs and ultrasounds to further aid in diagnosis.

Kruse says that ultrasound core biopsies help doctors direct the needles used for the biopsy and “prevents the patient sometimes from going into surgery.”

A stereotactic biopsy unit is “more like a mammogram image,” Kruse says. “It kind of diagrams a path into the breast where the calcifications are located. The patients lies on her stomach on a table … and the doctor and technologist sit on stools to get tissue samples.”

As with other cancers, early detection increases your chances of survival. It also decreases the invasiveness of the procedure needed to eradicate the cancerous tissue.

Not that many years ago, women suspected of having breast cancer went into surgery not knowing if they would wake up with both breasts. Surgery was used as a means of diagnosis and a mastectomy was performed immediately if cancer was found.

Today’s women most frequently undergo a lumpectomy — a procedure in which just the cancerous growth and some of the normal breast tissue surrounding it are removed.

“I do some things the operating room staff tell me they’ve never seen before,” Dr. Tisinai says. For a lumpectomy, “I’ll sit her up to see how the breast falls and manipulate the breast to make it as normal-looking as possible, to get the most natural breast appearance.”

However, those who need a mastectomy, or who could get by with a lumpectomy but want a mastectomy, and are candidates for immediate breast reconstruction are sent to Indianapolis. Why? Nobody in Terre Haute does breast reconstruction.

“I think it’s important to do what is best for the patient,” Tisinai says. Immediate breast reconstruction, during which the doctor works with a plastic surgeon, is done differently and results in a more natural-looking breast.

Lumpectomies are outpatient surgery, while mastectomies usually result in an overnight hospital stay.

Don’t forget the advantages of having regular clinical breast exams, where a medical professional examines your breasts, or doing breast self-exams to feel for lumps. Finding something doesn’t necessarily mean you have breast cancer, but can alert you to get a mammogram.

        

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